TEF & EA Bsc Nursing 5th sem.....BBBpptx

TRACHEO-OESOPHAGEAL FISTULA
&
ATRESIA
PRESENTED BY …….
MS ANEETA SHARMA
MSC TUTOR (PEADIATRIC NURSING)

MS ANEETA SHARMA

INTRODUCTION
•Tracheooesophageal fistula and atresia is the are the
malformation of the digestive tract .
•In which oesophagus dose not develop properly .
•Oesophagus is the tube that normally carry food from the mouth
to the stomach.
•Oesophagus development start from 4th
week of gestation in
embryo.
•Development of lower respiratory tract start from day 22 and it
continue from trachea, lungs, bronchi and alveoli.
MS ANEETA SHARMA

PATHOPHYSIOLOGY
The cephalocaudal end of the embryo
forms primitive gut cavity
Foregut,midgut,Hindgut
During 4TH
week of gestation, a small diverticulum appear in the ventral
wall of the pharynx
Pharynx is divided in to two part
Ventral portion dorsal portion
MS ANEETA SHARMA

Respiratory primordium Esophagus
If it is fail to develop then it will caused TEF & EA
Proximal end of esophagus terminate in a blind pouch and distal end connect
to the trachea by a fistula
TEF& EA
MS ANEETA SHARMA

DEFINITION
Oesophageal Atresia –
EA is the failure of oesophagus to form a continuous
passage from the pharynx to the stomach during
embryonic development .
Oesophageal Fistula-
TEF is the abnormal connection between the trachea and
the oesophagus.
MS ANEETA SHARMA

INCIDENCE
• TEF occurs in 1 in 3500-5000 birth ,with slight male dominance.
• EA with or without TEF is common in prematurity ,with 34% case
weighting less than 2500grams.
• Approx 50% of neonates with EA & TEF have other anomalies that are
represented by acronym “VACTERL”
• V-vertebral Column defect
• A- anorectal malformation
• C- cardiac defect
• TE-
• R-renal anomalies
• L-limb anomalies MS ANEETA SHARMA

ETIOLOGY -
•The exact cause of these anomalies are unknown
•Heritable genetic factors (trisomy at 13,18,21 )
•Radiation
•Drugs
•Maternal infection
•Polyhydramnios
MS ANEETA SHARMA

TYPES OF EA & TEF
Tracheoesophageal fistula and atresia are 5 types
TYPE-1-
•In this types , there is oesophageal atresia .
• The proximal and digital ends of the oesophagus are blind.
•There is no communication between trachea and oesophagus .
•This type is present in 3-5% of cases.
MS ANEETA SHARMA

TYPE-2-
•In this types ,oesophageal atresia is present and the blind
proximal segment of oesophagus connect with trachea with
fistula.
•The distal end of oesophagus is blind/Atresia.
•This type present 0.8% cases.
MS ANEETA SHARMA

TYPE-3-
•The proximal end of oesophagus is blind pouch/Atresia.
• The distal end of oesophagus connect by fistula to trachea.
•This is the commonest types present in 87% cases.
MS ANEETA SHARMA

TYPE-4-
•It is the rarest types that occurs in 0.7% cases.
•In this types upper(proximal) and lower(distal) segment of
oesophagus communicate with trachea by fistula.
MS ANEETA SHARMA
MSC TUTOR (PEADIATRIC
NURSING)

TYPE-5-
•In this types ,oesophagus and trachea are normal and
completely formed but are connected by the fistula .
•This types is also known as H type.
• It present in 4.2% cases.
MS ANEETA SHARMA

CLINICAL FEATURE
Clinical features appears soon after birth
 violent response occurs on feeding ,3 C
Coughing
Choking
Cyanosis
MS ANEETA SHARMA

Excessive and constant drooling (salivation)
In type-3 Saliva is frothy
Abdominal distension occurs in type3,4,5 fistula.
 FTT( delayed growth due to nutritional deficiency)
 Aspiration Pneumonia
Poor weight gain
MS ANEETA SHARMA

DIAGNOSTIC EVALUATION
• The diagnosis of TEF can made antenatally by USG of pregnant
women polyhydramnios.
• The disorder is detected soon after birth when infant shows by 3C
coughing ,choking & cyanosis in response to feeding.
• As soon as diagnosis is suspected, an attempt is made to pass feeding
tube by nose and mouth.
• An X-ray by Barium swallow of chest show air filled oesophagus and
air in stomach.
• An ultrasound enable identification of the types of trachea-
oesophageal fistula
MS ANEETA SHARMA

MANAGEMENT
1- Pre-operative care
As soon as the diagnosis of TEF is establish ,oral feeding are stopped
NPO.
Parental nutrition (IV fluid )are administer as prescribed by the physician.
Maintain intake and output chart
Keep the infant in semi-upright position. MS ANEETA SHARMA
NURSING)

A gastrotomy tube may be placed ,before surgery to aid
in gastric decompression .
Monitor vital sign of infant.
To clean the blind pouch by vacuum aspiration .
To provide broad spectrum antibiotics ,prevent
suspected infection.
Keep the suction equipment at bed side.
MS ANEETA SHARMA

SURGICAL MANAGEMENT
•The management of tracheoesophageal fistula is mainly
Reconstructive surgery.
•End to end Anastomosis of the proximal and distal segment of
oesophagus.
MS ANEETA SHARMA

2-Post-operative care-
Keep the baby NPO.
IV therapy continue.
DO Barium swallow using X-ray to find out anastomosis is healed or not.
Test feeding is given with glucose water.
Small amount of clear fluid/milk after 6-7 days of surgery. MS ANEETA SHARMA
NURSING)


Position the baby comfortably in semi-fowlers position.

Administer the prescribed analgesic.

Provide calm and quite environment so that the baby may rest.

Discharge planning must be done and explain the parents about
follow-up care.

Refer parents for genetic counselling that may help them in future.
MS ANEETA SHARMA

TEF & EA Bsc Nursing 5th sem.....BBBpptx

More Related Content

Similar to TEF & EA Bsc Nursing 5th sem.....BBBpptx (20)

More from AneetaSharma15 (20)

Recently uploaded (20)

TEF & EA Bsc Nursing 5th sem.....BBBpptx